Supplemental oxygen, position patient on left side, emergent delivery of infant
Defined as spontaneous abortion, loss of pregnancy prior to 20 weeks of gestation
Symptoms include spotting or bleeding accompanied by lower abdominal cramping
D. Supine hypotension syndrome
Defined as compression to the vena cava resulting in hypotension
Prevention: elevate right hip 1 to 2 inches; spine board tipped up so patient is slightly tilted onto her left side; abdomen and uterus can be manually pushed and displaced to the left off the vena cava
A. Three stages of labor
First stage—contractions to complete dilation of cervix
Second stage—delivery of fetus
Third stage—delivery of placenta
B. Signs of imminent delivery
Rupture of amniotic sac
Urge to push or defecate; do not allow the mother to go to bathroom
C. Crowning—bulging; check for umbilical cord visible
D. Evacuate patient to location accessible to EMS if:
Access point can be reached in 20 minutes
Umbilical cord or a part other than the baby’s head is visible in the vaginal opening
Mother indicates breech presentation or need for c-section
Baby’s head is not visible on inspection of the perineum during a contraction
E. Delivery not imminent, place patient on left side in lateral recumbent position, give oxygen, transport to hospital
If kit not available, improvise by obtaining clean towels and sheets, blanket for baby, 4x4 gauze sponges, scissors or straight-edged razor, soft rubber bulb syringe, white cloth tape, two clean shoelaces (sterilize all if time)
Standard Precautions throughout, place all supplies soiled with body fluids in biohazard bag and dispose of properly
Assist mother, remove clothing from waist down, place her on a firm padded surface, elevate pelvis 2–4 inches
Place clean sterile sheet under mother’s buttocks, creating delivery field
Crowning—allow mother to push, apply gentle pressure to head, suction baby’s mouth, then nostrils (note if fluid in mouth does not appear clear, sign of meconium)
Feel for umbilical cord around neck, remove, and recheck
If unable to lift cord over baby’s head, immediately place two clamps or umbilical ties around the cord about 2 inches apart and cut cord between the clamps
See upper shoulder, gently guide head down slightly to help deliver the shoulders
Never pull the baby
Once delivered, football hold, suction mouth and nose again, maintain airway
Standard Precautions, ABCDs, rapid survey, early critical interventions include high-flow oxygen
Spine board needed, tip to patient’s left side
Transport rapidly, EMS
You are called to the ski school instruction area, where a 26-year-old woman who is observing her toddler in a class has slipped and fallen on hard packed snow. The woman is 34 weeks pregnant and is complaining of severe abdominal pain. Upon your arrival, the woman is lying supine on the snow with both knees flexed. She is awake and oriented, and very worried that her unborn child may have been injured. A ski school instructor witnessed the incident and reports that she fell onto her left side, striking her abdomen. The woman describes her abdominal pain as “sharp” and “all over,” and unlike the labor contractions she had during her first delivery. She does not feel any leakage of fluid and denies feeling lightheaded. She reports that her second pregnancy has been uncomplicated to date, and that a recent ultrasound showed a single male fetus. She denies any injury other than that to her abdomen. As you assess the patient, you notice that her radial pulse is quite weak and seems faster than normal.
What should you do? Case Update
Recognizing that this woman, who is 34 weeks pregnant, has sustained blunt abdominal trauma, you assess her for additional trauma, including any obvious bleeding, tenderness in the neck, spine, or abdomen, and neurological deficits. You note that the patient’s abdomen is diffusely tender. The uterus rises to about 5 finger widths above the umbilicus and is very firm to the touch. You get assistance in positioning the patient onto her left side and obtain her vital signs. Her blood pressure is 90/60, her pulse is 110, and her respirations are 20 and shallow.
What are the potential consequences of blunt abdominal trauma during pregnancy?
What should you do next? Case Disposition
After placing your patient on her left side, her pulse rate remains at 110 but is much stronger, and a repeat blood pressure reading is now 105/70. She continues to complain of severe abdominal pain, and reassessment shows her uterus to be continuously firm. You place the patient on high-flow oxygen by nonrebreather mask while arranging emergency transportation to the hospital.
You transport the patient, lying on her left side, by toboggan to the patrol facility, where an ALS ambulance crew is awaiting her arrival. Two days later, the patient’s husband stops by the patrol room to thank you and the other patrollers. He reports that his wife was diagnosed at the hospital with abruptio placentae. She underwent an emergency caesarian section to deliver a 3-pound baby boy who is on a ventilator in the neonatal intensive care unit but is doing well. He tearfully notes that without your prompt care and rapid evacuation, he could have lost not just his wife, but his newborn son as well!
Have you ever witnessed a live birth? What was it like?
Does your area have an OB kit? Where is it kept? What is included in the kit?
Has there ever been a live birth at your area?
What are some of the accidents that could occur at your area that could result in gynecological trauma?
Are OEC Technicians mandated by law to report suspected sexual assault to law enforcement?
Does your area have a protocol for reporting assaults?